ITHE MANAGEMENT OF ACUTE CIRCULATORY FAILURE IN AN INJURED LIMB 281

Sudden arrest of the circulation in a limb is a catastrophe of particular interest to the orthopaedic surgeon because, apart from embolism and arterial disease, this emergency is almost confine(l to the vascular complications of fractures and dislocations. Crushing injuries of a limb, and accidents after the use and abuse of tourniquets are rare. The fractures in which the circulation is most in peril are those of the lower end of the humerus, the tipper parts of both bones of the forearm, the shaft an(l lower end of the femur, and the upper two-thirds of the leg bones. Actual gangrene complicating fractures in civil life occurs with greatest frequency when both anterior and psterir tibial arteries are injured as the result of high fracture of the tibial shaft, but arterial injury as such is found most Supracondvlar fracture lower end of humerus in a child of eight years with loss of radial pulse but no ischaemia of hand or forearm. l’here was no nerve lesion. often in association with the much more common supracondylar fracture of the lower en(l of the humerus (Fig. 1). The combination of fracture with vascular obstruction is nearly always the result of severe injury, and the dice are loaded against the surgeon who must work upon the badly damaged ischaemic limb of a patient with little reserve of strength